Mechanism Of Labour And Vaginal Examinations

Question 1

What is meant by flexion?

Answer 1

The baby holds its chin to its chest to make a smoother exit through the birthing canal.

Question 2

What is an ischial spine?

Answer 2

A landmark on the mothers pelvis which we use to detect how engaged the foetal head is. We talk about foetal head engagement in 5ths. We refer to the position of the foetal head in relation to the ischial spines as the ‘station’ of the foetal head.

Question 3

During a VE, what are we looking for in relation to the cervix.

Answer 3

1. The dilation of the cervix. This is assessed on a scale of 1-10cm. 10cm is fully dilated.
2. The effacement of the cervix. This is how stretched the cervix is over the head of the foetus. The more stretched the cervix is, the thinner it will feel.
3. The position of the cervix. Whether it is central, posterior or anterior.

Question 4

During a VE what are we looking for in relation to the foetus?

Answer 4

1. The presentation of the foetus. Whether they are cephalic, breech or transverse.
2. Position of the foetus. At which point on the pelvis is the occiput of the foetal head. E.g. LOA, ROA, LOP, ROP, LOL, ROL.
3. Engagement of the foetal head in relation to the ischial spines. At what station is the foetal head? How many 5ths?

Question 5

There are 10 things we must do before the VE procedure. What are these.

Answer 5

1. Explain procedure
2. Gain consent
3. Check patient has emptied bladder
4. Ensure client is in a comfortable position (without underwear)
5. Maintain patients dignity by ensuring privacy - door shut, sheet to cover lower body
6. Place disposable sheet under bottom
7. Wash hands
8. Apply sterile gloves
9. Apply lubricating gel to hands
10. In practise we have to mention that before a VE we would carry out a abdominal palpation. In an OSCE we would not have to do this.

Question 6

How can we encourage a woman to make herself more comfortable for a VE?

Answer 6

The woman can place a fist under the base of her spine to lift the cervix.

Question 7

How could we determine a breech baby using a VE?

Answer 7

Feel for the fetal head. Feel for suture lines and fontanelles. We can also feel the cheek bones on the face of the foetus which would NOT occur on the cheeks of the bottom. We would also establish an idea of presentation using an abdominal palpation (which would be carried out prior to a VE).

Question 8

What are five landmarks we could feel for on the foetal skull?

Answer 8

• anterior fontanelle
• posterior fontanelle
• coronal suture
• lambdoidal suture
• frontal suture

Question 9

What are the 6 mechanisms of labour?

Answer 9

1. Decent of the presenting part
2. Flexion of the foetal head
3. Internal rotation of the occiput
4. Extension of the foetal head
5. External rotation (restitution)
6. Lateral flexion

Question 10

What is meant by lateral flexion?

Answer 10

The baby emerges (is born)

Question 11

What is the opposite of flexion in terms of mechanisms of labour?

Answer 11

Extension- the foetal neck extends as it begins to emerge

Question 12

When the foetus rotates internally, what position does it fall into?

Answer 12

Occipitoanterior- so that the foetal occiput lies at the front of the woman’s pelvis

Question 13

What is another word for external rotation?

Answer 13

Restitution